O'Malley Ann S, Gourevitch Rebecca, Draper Kevin, Bond Amelia, Tirodkar Manasi A
Mathematica Policy Research, 1100 1st St., NE, 12th Floor, Washington, DC, 20002-4221, USA,
J Gen Intern Med. 2015 Feb;30(2):183-92. doi: 10.1007/s11606-014-3065-9.
There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams.
The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy.
Practices for this qualitative study were selected from those recognized as patient-centered medical homes (PCMHs) via the most recent National Committee for Quality Assurance PCMH tool, which included a domain on practice teamwork.
Sixty-three respondents, ranging from physicians to front-desk staff, were interviewed from May through December of 2013. Practice respondents came from 27 primary care practices ranging in size, type, geography, and population served.
Practices emphasizing teamwork overcame common challenges through the incremental delegation of non-clinical tasks away from physicians. The roles of medical assistants and nurses are expanding to include template-guided information collection from patients prior to the physician office visit as well as many other tasks. The inclusion of staff input in care workflow redesign and the use of data to demonstrate how team care process changes improved patient care were helpful in gaining staff buy-in. Team "huddles" guided by pre-visit planning were reported to assist in role delegation, consistency of information collected from patients, and structured communication among team members. Nurse care managers were found to be important team members in working with patients and their physicians on care plan design and execution. Most practices had not participated in formal teamwork training, but respondents expressed a desire for training for key team members, particularly if they could access it on-site (e.g., via practice coaches or the Internet).
Participants who adopted new forms of delegation and care processes using teamwork approaches, and who were supported with resources, system support, and data feedback, reported improved provider satisfaction and productivity. There appears to be a need for more on-site teamwork training.
越来越多的人达成共识，即加强跨专业团队合作对于有效且高效地提供初级保健服务是必要的，但针对初级保健的实用信息较少，无法指导实践如何更好地作为团队开展工作。
本研究的目的是描述初级保健实践如何克服提供基于团队的初级保健服务所面临的挑战，以及对医疗服务提供和政策的影响。
通过最新的国家质量保证委员会的以患者为中心的医疗之家（PCMH）工具，从被认可为PCMH的机构中选择参与这项定性研究的实践机构，该工具包括一个关于实践团队合作的领域。
2013年5月至12月期间，对63名受访者进行了访谈，受访者范围从医生到前台工作人员。参与实践的受访者来自27个初级保健机构，这些机构在规模、类型、地理位置和服务人群方面各不相同。
强调团队合作的实践机构通过逐步将非临床任务从医生手中委托出去，克服了常见的挑战。医疗助理和护士的角色正在扩大，包括在医生门诊前根据模板指导从患者那里收集信息以及许多其他任务。让工作人员参与护理工作流程重新设计，并利用数据展示团队护理流程的改变如何改善患者护理，有助于获得工作人员的认同。据报告，由就诊前规划指导的团队“碰头会”有助于角色委托、从患者那里收集信息的一致性以及团队成员之间的结构化沟通。发现护士护理经理是与患者及其医生合作进行护理计划设计和执行的重要团队成员。大多数实践机构没有参加过正式的团队合作培训，但受访者表示希望为关键团队成员提供培训，特别是如果他们可以在现场获得培训（例如，通过实践指导教练或互联网）。
采用团队合作方法采用新的委托形式和护理流程，并获得资源、系统支持和数据反馈的参与者报告称，提供者满意度和生产力有所提高。似乎需要更多的现场团队合作培训。
